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Antiwrinkle Injections for Chin Dimpling

Author: Dr Naomi / 28 Oct 2015

As we age and lose bone and soft tissue on the face, the chin can become less smooth, with dimpling and a bobbly appearance. This can be more obvious when a patient is talking, with the dimpling standing out with certain movements in the area.

“Bobbly chin” can be treated with muscle relaxing injections . Dermal fillers can also be used
TREATMENT OF CHIN DIMPLING
The first line treatment for chin dimpling is antiwrinkle injections (due to Australian regulations, we are not allowed to name the drugs used) , the area may be improved even further by injecting dermal filler.
Small injections using a very fine needle are performed to the chin area into the muscles which cause the dimpling . Typically about 4 injections  will be performed

The consultation for antiwrinkle injections for frown lines
History-taking  is very important in the treatment of frown lines. The following should be explored:
Is there a genetic component? ie are there others in the family who have a strong frown line at an earlier age? How has this progressed?
Has the patient had treatment before?
Were they happy every time?
Did the effect of the antiwrinkle injections last well?
Which area came back first?
How is the patient’s metabolism? Do they exercise? Are they very muscular? Do they have trouble putting on or losing weight?
Is it the vertical frown line, or the horizontal line between the brows which are bothering the patient
Have they every had any complications, eg strange smile, asymmetry of the mouth etc
The examination
The doctor will examine the face and chin area. In particular, she will look at many features, such as:
Where the dimpling is.
Whether there is an asymmetry.

Whether there is a horizontal chin crease (the mental crease)
Whether the chin dimpling is etched in at rest.
The type of skin, whether there are a lot of large pores in the area

How deep the marionettes are.

How is the projection of the chin area
Choosing the dose of 
The doctor will assess the face and decide on the best dose after taking a history and examining the patient.
If the patient has a history of poor longevity, or needing high doses or wanting maximal effect, then a higher dose may be suggested
If a patient has a history of complications with muscle relaxing injections, or if their budget is small or if they want a more subtle result, then a smaller dose might be chosen.
Pain relief during treatment
A numbing cream (eg EMLA or LMX ) may be applied to the area prior to the treatment (45 minutes prior is ideal) Glad wrap may be used over the numbing cream to increase its effect.
Most patients do not bother with numbing cream because it takes so long to work and because the treatment isn’t very painful anyway.
Ice is always used to decrease pain and to reduce the risk of bruising.
Very rare patients will use Penthrox for frown line treatments

Nitrous oxide / Happy gas is available to patients
If the patient requires dermal filler, then typically local anaesthetic may be injected in the area of the chin first
What happens during the frown line treatment itself?
The face will be cleaned with alcohol.
Ice will be applied to the area briefly before treatment
The doctor will inject approx 4-6 sites around the chin, injecting the muscles that are responsible for the dimpling. Then pressure with gauze will be applied.
The procedure itself takes less than 5 minutes.
How do I look afterwards?
Sometimes there is nothing to see. Sometimes there can be redness, small lumps, which can look like mild acne and usually resolve quite quickly.
Most people could come during their lunch break during work and go back without their coworkers noticing anything
Side Effects and risks of antiwrinkle injections for chin dimpling
In general, treatment of chin dimpling is very low risk.
Headache happens in around 10% of new users.
Bruising occurs in a significant number of cases.
Asymmetry: Often one side is better treated than the other, this is usually because the patient is asymmetrical to start with.
Infection is a very rare complication, but always a possibility when the needle goes into the skin.
It is possible that speech or the smile may be affected with treatment in the lower face. However at the typical doses used this is very uncommon. The risk increases with larger doses
Instructions for care afterward
No makeup for 4 hours
No massage that day
No heavy exercise that day
No lying down for 4 hours
Lay off the acid face products for 24 hours
What to expect after frown line treatment?
The effect of the injections will not start to occur for 2-8 days.
The maximal effect of the drug will be at 3-4 weeks, so a review should be booked in at 3 weeks (only after the first treatment, for subsequent injections, a review appointment shouldn’t be required)
What if I get asymmetry at some time before the 3 week point? Do I call the doctor?
No. No need to call the doctor. Sometimes asymmetry will occur because one side just comes on quicker than the other. Usually it will right itself by the time of the review appointment. If it doesn’t, then it can be treated at the review appointment. There is no point in coming in early for treatment of asymmetry. Treating asymmetry too early could lead to droop or further asymmetry
What do I do if at 3 weeks post treatment I still have a bobbly chin?
A top up dose will be performed at the review appointment.

Dermal filler may also be considered

How long will the treatment last?
The answer to this is very individual and depends on the patient’s metabolism, the dose, the placement etc.
Typically this is what happens:
At 3-4 weeks, there is a maximal effect
at 8 weeks, movement starts to return
at 12 weeks, 50% of movement should be back
at 16 weeks 80% of movement should be back.
With an adequate dose, for most patients, this is very close to what occurs.
When should I have my next treatment for chin dimpling?
Patients should be retreated when the movement is between 50%-80% back ie sometime from 3-4 months.

Some patients have treatment every 8 weeks because they do not like any movement at all
Price for antiwrinkle injections in chin dimpling
Typically $260. If other areas being treated then it will be cheaper

Other procedures which would be suitable to combine with “bobbly chin” antiwrinkle injections
* Microlaser Peel
* Fractional laser
* Dermal Fillers in frown line
* Skin Boosters
* Antiwrinkle injections  in other areas

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